A new cascade of HIV care for the era of ‘treat all’

Now that the World Health Organization has recommended antiretroviral therapy for all people infected with HIV regardless of their CD4 count, millions more people will become eligible for HIV treatment.
· We and others have previously described the cascade of care for HIV treatment for monitoring retention in care and targeting interventions to improve retention to areas of greatest need.
· To inform research and track progress, we propose a new cascade for the “treat all” policy that effectively removes the pretreatment waiting period.
· Current data on retention through each stage of care will have limited value under this new cascade, as some stages will no longer exist while others will include patients who were previously not eligible.
· New data are needed to parameterize the care cascade under the ‘treat all’ policy, and new interventions will be needed to improve retention across the new cascade.